The creation of the Bradford Hospitals Trust as part of the changes imposed on the NHS 18 months ago exposed such weaknesses in its management and accounting systems that it has been forced to consider returning to district health authority control.
After monitoring the hospital group over its first year as a trust for his BBC Television Troubleshooter series, Sir John Harvey-Jones, the industrialist, said that huge investment was needed to fulfil the Government's promise that money would follow patients under the changes.
In the programme, to be broadcast tomorrow night, Sir John tells managers they are 'steering blind' with no clear, long-term financial strategy. The programme charts the frustrations felt by several consultants, for whom promises of better facilities and staff have failed to materialise. 'There is nothing but disappointed people, being let down in this place,' Sir John says.
Rodney Walker, a Bradford businessman who chairs the hospital trust, complains in the programme that many of the new freedoms claimed by health ministers to be the hallmark of trusts are illusory.
'They are not real freedoms. We cannot go out and invest money of our choice into developing the estates at one of our main sites, the Bradford Royal Infirmary, to enable us to make revenue savings elsewhere,' he said.
Apart from the rambling Victorian buildings of the infirmary and St Luke's, both in the city, the trust runs an elderly care hospital, Bierley Hall, and the Woodlands orthopaedic hospital on the outskirts. Within weeks of its launch as a trust, the hospital group announced 300 redundancies as part of a three-year programme to make pounds 7m- worth of savings.
Mark Baker, its first chief executive, resigned after only seven months, having been taken to task by the Commons health select committee for putting in a trust application it regarded as over-optimistic. The trust ended its first year last April pounds 1.7m overspent.
In a review of management arrangements in June this year, David Jackson, Dr Baker's successor, said a major overhaul was necessary to remedy the trust's failure to meet both its own objectives and its statutory obligations. 'I have become increasingly concerned that no one is 'in charge' of the two main institutions, St Luke's and the infirmary.'
This week, the trust is to publish ambitious plans to centre all its services in a new pounds 100m building on the St Luke's site. The blueprint for the complex, backed by the medical staff and due for completion in 2005, envisages a reduction in the trust's present beds from 1,370 to 850. The Department of Health said it had not sanctioned the proposals, but has asked the trust for a detailed business plan to support its case.
Private ambulance companies have backed Opposition calls for statutory regulation of their industry after the operator of Britain's first independent 999 service was revealed to be a convicted criminal.
Richard Sage, who runs Belmont Medicover Ambulance Services from an undertaker's premises in Woking, Surrey, was sentenced to five years in prison on six charges of fraud and deception in 1986, it emerged earlier this month. The company claimed it could provide a 'fast and efficient alternative' to the NHS 999 service for an annual subscription of pounds 35 per individual or pounds 65 for a family.
A recent survey by Paramedic UK, an association of private pre-hospital care specialists, of 200 private ambulance operators found that only 1 in 20 had staff trained to recommended NHS standards.
Priv-Amb Services, a Peterborough- based consultancy that advises around 40 independent ambulance services, believes a growing prevalence of 'cowboy operators' has made the case for regulation unanswerable. 'They have unqualified staff, ill-maintained equipment, and inadequate insurance,' a spokesman said. 'Without a form of compulsory registration, this type of trade will continue.'